cardiac physiotherapy

CardioVascular Diseases – Improving Heart Health via Cardiac Rehab Program

India is one of the most populous countries in the world. The present health scenario suggests that our country is undergoing an epidemiological transition. The epidemiological infectious diseases are getting superseded by the non-communicable diseases (NCD). Estimates indicate that NCDs account for 53% of total deaths in India & Cardiovascular diseases (CVD) mortality tops the list of NCD deaths with 45% of deaths accounted by CVD.#1

Increasingly even the government setups in India are also acknowledging and approving of Cardiac Rehab Programs as effective and needed to ensure SPEEDY Recovery and enhance surgical OUTCOME (cardiac surgery).

CARDIOVASCULAR DISEASES

Cardiovascular diseases (CVDs) are a class of diseases that involves heart or blood vessels.

Common CVDs include-

  • Ischaemic Heart Disease (IHD)
  • Hypertensive Heart Disease (HHD)
  • Rheumatic Heart Disease (RHD)
  • Cardiomyopathies
  • Congenital Heart Disease (CHD)
  • Peripheral Artery Disease (PAD)

The underlying mechanism varies for the above mentioned diseases; the most common cause being atherosclerosis.

RISK FACTORS FOR CVDs

  • Hypertension
  • Smoking
  • Excessive alcohol intake
  • Diabetes
  • Obesity
  • High blood cholesterol
  • Poor diet
  • LACK OF EXERCISE & SEDENTARY LIFE STYLE

However it is estimated that 90% of CVDs are preventable.

Also most of the CVD patients can help lower their risk of future heart problems if they make changes to improve their health.

CARDIAC REHABILITATION

What is Cardiac Rehabilitation?

Cardiac Rehabilitation (Cardiac Rehab) is a professionally supervised program to help people recover from heart attacks, heart surgeries, percutaneous coronary intervention procedures such as stenting & angioplasties.

Cardiac Rehab program usually provide education & counselling services to help heart patients increase physical fitness, reduce cardiac symptoms & improve health.

BENEFITS OF CARDIAC REHAB

  • Reduction in all cause mortality rate by 20-30% (as per AHA)
  • Reduced cardiac symptoms (angina, dyspnea, fatigue)
  • Improved adherence & preventive medication
  • Increased exercise performance
  • Improved quality of life.

Increasingly even the government setups in India are also acknowledging and approving of Cardiac Rehab Programmes as effective and needed to ensure SPEEDY Recovery and enhance surgical OUTCOME.

What kind of services does the Cardiac Rehab Program offer?

(Read more details at http://reliva.in/knowledge_center/cardiac-rehab–staying-heart-healthy )

  • Appropriate recommendations are made for medical examination, physical activity & exercises,  based on the risk stratification process as per the American College of Sports Medicine (ACSM) that assigns participants into 3 categories-
  • Low Risk
  • Moderate risk
  • High Risk
  • A comprehensive health fitness evaluation typically includes the following before the planning & prescription of the Cardiac Rehab program
  • Resting Heart rate, BP, Height, Weight, BMI, ECG
  • Cardiorespiratory Fitness (if required) – TMT
  • Muscular Strength – RM method
  • Flexibility
  • An exercising training program is best designed to meet the individual’s health & physical fitness goals.

COMPONENTS OF EXERCISE TRAINING

  • Cardiovascular (aerobic) fitness
  • Muscular strength & endurance
  • Flexibility

Exercises that improve neuromuscular fitness such as balance & agility are also recommended by ACSM particularly for older adults & highly deconditioned persons.

ACSM also recommends loading exercises (i.e. weight bearing & resistance exercises) to maintain bone health.

A single exercise session includes the following-

Cardiac Rehab in Progress at Reliva
Cardiac Rehab in Progress at Reliva
  • Warm –up – at least 5 to 10 minutes of low <40% to moderate intensity cardiovascular & muscular endurance activities.
  • Stretching – at least 10 minutes of stretching exercises performed after warm up or cool down phase
  • Conditioning – this phase includes aerobic/resistance &/or sports related exercises
  • Cool Down – at least 5-10 minutes of low (<40% to moderate 40% -<60%)intensity of cardiovascular & muscular endurance activities.

Cardiac rehabilitation takes place as

  • In-patient Rehabilitation Programs
  • Outpatient exercise Programs

Outpatient cardiac rehab programs should begin as soon as hospital dismissal.

Most patients are capable of beginning a supervised exercise program with 1-2 weeks of leaving the hospital.

SUMMARY OF THE ACTUAL CARDIAC REHAB PROGRAM

  • While actual training program for each patient would differ, an indicative plan would be as follows:
COMPONENTSACTIVITIESRECOMMENDED TIME
Warm upStretching/low level calisthenics10 minutes
Aerobic ConditioningTreadmill (Mod Bruce/Bruce protocols or other protocols as indicative), cycle ergometer, cross trainer, stair stepping20-30 minutes as tolerated
Muscular ConditioningWeight training15-30 minutes as tolerated
Cool DownSlow walking/ stretching5-10 minutes
  • An indicative exercise prescription would be as follows (FITT Priciple) :
Frequency3-5 days/week
IntensityRPE- 11-16/ 20-80% using Heart rate Reserve
TimeApprox 60 minutes
TypeTreadmill/elliptical/ Cycle ergometer/Cross trainer/stair climber
Resistance Training8-10 exercises (1 set per exercise of 8-12 reps) that conditions the major musle groups atleast 2 days per week
Initial level of FitnessHigh = higher work loadLow =  lower work load

 

Having the essence of the details about Cardiac rehabilitation, it is important to take up these best benefitting programs seriously by moving out of the cages of ignorance & myths about CVD’s.

The larger group of hospitals do provide the cardiac rehab services but they reach out to the very few.

Its time we start giving importance to clinic based Cardiac Rehab programs who plan for the Outpatient Exercise programs for cardiac patients.

ReLiva Physiotherapy & Rehab Clinic in Navi Mumbai has taken an initiative towards providing this utmost care to the cardiac patients by providing clinically monitored & supervised Cardiac Rehab Outpatient programs.

We believe in “Exercise is Medicine”. (Read what our Cardiac Rehab patients have to say about us by clicking here.)

Like all medicines, ‘Effective Dosage” of exercise is important for achieving the desired results. “More” is not better. For cardiac patients, more exercise could be as or more dangerous as consuming higher dosage of medication than prescribed.

“Less” would not deliver desired & long term outcomes. Patients’ cardiovascular capabilities may remain suboptimal; thus impacting the quality of life & overall health.

Monitoring while cardiac rehab
Monitoring while cardiac rehab

“ Effective dosage” changes as physical capacity & capabilities change. Hence regular monitoring is critical to evaluate & arrive at “effective Dosage” at different stages of Cardiac rehab.

Read about Contribution of progress in a patient due to Cardiac Rehab Program : Patient at ReLivaTM in the next post by clicking here.

With these advances in Cardiac rehab, this program can become recognized as a cornerstone in a comprehensive management of cardiac patients.

More awareness is the prime necessity to optimize the effectiveness of the cardiac rehab program.

With such initiatives together we can definitely contribute towards a better life for the Cardiac patients.

Contributed by Dr. Anuradha Purohit – Mandlekar (PT). She is BPT, MPT(Cardio-thoracic), MIAP, American Health Association (AHA) certified specialist at ReLiva Physiotherapy & Rehab and pioneers the Cardiac Rehab Program.

#1- (ref – 2013, Vol.2, No.2,ISSN 2319-4154,Health Sciences E-Journal)

cardiovascular disease

Cardiac Rehab Program : Story of Recovery & Confidence

Indians have traditionally faced high mortality due to a wide array of Cardiovascular Diseases (CVDs), including those like Hypertension, blocked arteries, cholestrol leading to Ischaemic Heart Disease (IHD), Hypertensive Heart Disease (HHD), Rheumatic Heart Disease (RHD), Cardiomyopathies, Congenital Heart Disease (CHD), Peripheral Artery Disease. However it is estimated that 90% of CVDs are preventable.

Also most of the CVD patients can help lower their risk of future heart problems if they make changes to improve their health.

Cardiac Rehabilitation has emerged as a very reliable and sustainable protocol to improve cardiac health and improve outcomes of cardiac surgery.

Read what some of our Cardiac Rehab patients have to say, after completing the Rehab Program at ReLiva by clicking here.

What is Cardiac Rehabilitation?

Cardiac Rehabilitation (Cardiac Rehab) is a professionally supervised program to help people recover from heart attacks, heart surgeries, percutaneous coronary intervention procedures such as stenting & angioplasties.

Cardiac Rehab programs usually provide education & counselling services to help heart patients increase physical fitness, reduce cardiac symptoms & improve health.

BENEFITS OF CARDIAC REHAB

  • Reduction in all cause mortality rate by 20-30% (as per AHA)
  • Reduced cardiac symptoms (angina, dyspnea, fatigue)
  • Improved adherence & preventive medication
  • Increased exercise performance
  • Improved quality of life.

More details of what goes in a Cardiac Rehab Program can be found at an earlier post. Click here to read.

Increasingly even the government setups in India are also acknowledging and approving of Cardiac Rehab Programmes as effective and needed to ensure SPEEDY Recovery and enhance surgical OUTCOME.

Cardiac rehabilitation takes place as

  • In-patient Rehabilitation Programs
  • Outpatient exercise Programs

Outpatient cardiac rehab programs should begin as soon as hospital dismissal. Most patients are capable of beginning a supervised exercise program with 1-2 weeks of leaving the hospital.

Its time we start giving importance to clinic based Cardiac Rehab programs who plan for the Outpatient Exercise programs for cardiac patients.

ReLiva Physiotherapy & Rehab has taken an initiative towards providing this utmost care to the cardiac patients by providing clinically monitored & supervised Cardiac Rehab Outpatient programs.

We believe in “Exercise is Medicine”.

Like all medicines, ‘Effective Dosage” of exercise is important for achieving the desired results. “More” is not better. For cardiac patients, more exercise could be as or more dangerous as consuming higher dosage of medication than prescribed. “Less” would not deliver desired & long term outcomes. Patients cardiovascular capabilities may remain suboptimal; thus impacting the quality of life & overall health.

“ Effective dosage” changes as physical capacity & capabilities change. Hence regular monitoring is critical to evaluate & arrive at “effective Dosage” at different stages of Cardiac rehab.

Here is a real story about the progress of a patient due to Cardiac Rehab Program at ReLivaTM

A 66 year old male was experiencing chest heaviness & restlessness. The intensity of chest discomfort increased & extended to the epigastric region after which the patient was admitted to the hospital. The patient was diagnosed with ischeamic heart disease & had an LVEF of 25-30%. Tha patient was advised external counterpulsation therapy & he was later referred to cardiac rehabilitation.

S – “ I had a cardiac episode 3 months back”

O –Vitals – WNL/ BMI- 26 kg/m2

No acute distress, Regular heart rate.

C/o early fatigue on walking for more than 15-20 minutes.

First 6 MWT – 308 meters-5.13 laps

Target Heart rate (THRlower limit – 93/ THRupper limit – 113)

P – Initiate a 4 week (12 sessions) rehabilitation program

EXERCISE PROGRAM GOALS :

  • Peak exercise tolerance > 6 MET’s
  • Increase functional capacity
  • Improve muscular endurance
  • Reinforce lifestyle changes
  • Improve overall quality of life.

The patient underwent 12 sessions of cardiac rehab which consisted of 4 muscular conditioning sessions & 8 cardiac conditioning sessions (mod bruce protocol).

In the initial 2 cardiac conditioning sessions, patient complained of chest heaviness on incline.

But subsequent sessions conditioned his heart helping him attain the Stage 5 of Mod Bruce protocol with THR-118, Speed-5 & an incline of 18 with al, the vital parameters within normal limit.

He chose to continue cardiac rehabilitation with a home based exercise programs.

For the home based exercise programs ReLiva also offers a unique remote monitoring technology in cardiac rehab by use of a Vital jacket.

Vital Jacket
Vital Jacket for Cardiac Rehab at ReLiva

Vital Jacket is the first certified medical device combining medical technology & mainstream engineering solutions.

It is an easy to wear t-shirt with a reliable cardio monitor.

VitalJacket is equipped with a Bluetooth transmitter, enabling users to view the signal in real time, before a recording takes place or during a training session. With this special feature, it is also possible to send the signal remotely to another location using either a computer or a PDA with an internet connection.

QUALITY CONTROL & ASSURANCE:

Good results can be obtained with such sophisticated & higher standards services & can provide a greater flexibility in physical training, research opportunities & improve an overall standard of patients in the health care industry.

CONCLUSION & FUTURE DIRECTIONS:

Read what some of our Cardiac Rehab patients have to say after the Rehab Program by clicking here.

With these advances in Cardiac rehab, this program can become recognized as a cornerstone in a comprehensive management of cardiac patients.

More awareness is the prime necessity to optimize the effectiveness of the cardiac rehab program.

With such initiatives together we can definitely contribute towards a better life for the Cardiac patients.

Read more detailed description of the protocol of Cardiac Rehab Program in the previous post by clicking here.

Contributed by Dr. Anuradha Purohit – Mandlekar (PT). She is BPT, MPT(Cardio-thoracic), MIAP, American Health Association (AHA) certified specialist at ReLiva Physiotherapy & Rehab and pioneers the Cardiac Rehab Program.

cardiac rehab for healthy heart

Cardiac Rehab – Staying Heart Healthy

What is Cardiac Rehabilitation? cardiac rehab

Cardiac Rehabilitation is an individualized and personalized treatment plan, including evaluation and instruction on physical activity, stress management, and other health related areas.

An important part of the treatment of your specific heart problem. If you have one of the following diagnoses, you may be eligible to participate :
•    Heart Attack
•    Angina
•    Coronary artery angioplasty or stents
•    Open heart surgery such as coronary bypass or valve surgery
•    Heart failure

Even if you are prone to CVD,  a rehabilitation program  would mitigate the risk of a cardiac event.

Recent scientific studies have shown that people who complete a cardiac rehabilitation program can increase their life expectancy by up to five years.

Benefits of Cardiac Rehabilitation:

  • Live longer and lessen your chances for another heart attack
  • Control heart disease symptoms such as chest pain or shortness of breath
  • Stop or reverse damage to your blood vessels in your heart
  • Lessen the physical and emotional effects of heart disease
  • Improve your stamina and strength, getting you back to your usual activities, including work, hobbies, and regular exercise
  • Improve your confidence and well-being

Cardiac Rehabilitation Offers: 

1. A personalised, monitored and supervised exercise program incuding one or all of the following:

•  ECG

•  Heart rate

•  Blood pressure

•  SPO2

2. Assessment of your personal risk factors for heart and blood vessel disease

3. Education and support to make healthy lifestyle changes such as :

  • Maintaining a healthy weight
  • Beginning and maintaining a personalized exercise plan that works for you

ReLivaTM Cardiac Rehab program aims to deliver appropriate dosage of exercise under regular patient monitoring to achieve optimal cardiovascular capabilities.

Exercise = Medicine to keep your heart healthyCardiac rehab - Exercise is medicine to keep heart healthy

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